ABSTRACT OF THESIS submitted by Sally J. Giles for the degree of Doctor of
Philosophy and entitled, "Exploring the attitudes of health care professionals towards
incident reporting within three NHS trusts: a multi-method approach". August 2005
Adverse events are thought to occur in up to 16% of hospital admissions. As a result there
has been a drive towards establishing incident reporting systems as a an error prevention
tool. In health care these systems are typically based on those developed in other high-risk
industries. However they are often subject to high levels of underreporting and therefore
fail to establish the real causes of adverse events. Health care organisations aim to take a
systems approach to analysing error, therefore creating a low-blame culture. However a
number of inter-professional issues and a weak safety culture amongst health care
professionals can prevent this from taking place.
This study aimed to determine the attitudes of health care professionals towards incident
reporting. In order to achieve this a multi-method approach using both qualitative
interviews and a survey was employed in an attempt to triangulate the research findings.
Twenty-eight health care professionals from the department of orthopaedics in three NHS
trusts were interviewed and a survey developed from the interviewees was sent to all health
care professionals in orthopaedics at the three NHS trusts.
The findings from the survey complemented the qualitative data and were able to validate
some of the findings. In spite of a drive towards establishing a safety culture within the
NHS, there was still evidence of a weak safety culture and attitudes of health care
professionals towards incident reporting were very negative. The thesis drew particular
attention to the existence of subcultures within the NHS and how this may limit the use of
the theories and concepts used in other high-risk industries.